Assured continuity of workflow and ensured that the needs of customers are met
Prepares departmental correspondence, maintains departmental records, files, and forms.
Contacts referring facilities to obtain treatment documentation needed for the patients care.
HIPAA and OSHA compliant
Handled patient/insurance phone calls and/or correspondences in a timely manner.
Utilized computerized databases.
HIPAA Officer02/2013 to 01/2014Carolinas Center for SurgeryMorehead City, NC
HIPAA Training Train and Council Staff Internal Audits Patient Privacy Rights Business Associate Agreements HIPAA Violations Attending Webinars/Seminars Updating HIPAA Manual Ensuring HIPAA Compliance within the practice Documenting Violations.
Director of Patient Accounts04/2012 to 01/2014Carolinas Center for SurgeryMorehead City, NC
Handled Petty Cash Wrote Policy and procedures Management Meetings
Wrote Job Descriptions
Balancing charges, adjustments and payments Handled daily, weekly and monthly
Handled patient (customer) complaints
Preparing Daily Deposits
Approved Single Case Agreements with Insurance Carriers
Posting patient and Insurance Payments
Reconciled patients (customer) accounts
Research Patient Statements
Preparing Daily Deposits
Completing Reconciliation forms
Financial Reports Requested by Executive Director and/or Physician
Researching Codes and allowable amounts
Obtaining passwords for Billing Dept.
New Hires Employment Packets
Direct Keying of Claims into BCBS/Medicaid/Tricare and other insurance carrier Websites
Implemented the Patient Portal (Med fusion/Intuit)
Working Clearinghouse (Real Med/Availity) rejections
Developing New forms for the practice
Downloading/Uploading of ERA's
Managed Front Desk Staff, Authorization/Referral Staff, Billers, Coders, Medical Records, Payment Poster and Patient Accounting Representatives
Answering Billing questions
Verifying Insurance Coverage/Benefits on all patients
Scheduling/Canceling patient appointments
Entering Insurance Information and patient demographics on accounts
Verify Charge Entry
Prepare all medical claims for Billing and enter into GE Centricity PM electronic Billing Software and/or paper claims on CMS-1500 Form
Enter Co-pay/ Co-insurances/ self-pay information into GE Centricity PM
Keep abreast of all updates and changes to Insurance carrier claims processing procedures and communicate changes to staff
Create and submit requests for authorizations autonomously as necessary
Oversee appropriate authorizations procedures are maintained
Adding Referrals into GE Centricity PM
Payment Arrangements Collection Accounts
Coding Medical Billing for Prime, Secondary and Tertiary
Insurances Reconciling patient Accounts
Completing W-9's for our Company
Handling the General Ledger for the main locations and satellite offices
Invoicing For Hospital charges and special Contracts
Financial Reports for the CEO and Administration
Timecards and Authorizing employees time off requests
Annual performance reviews
Researched Coding Issues Internal Audits Denial Management Approved adjustments and refunds Attending Seminars and /or Conferences HIPAA/OSHA Training Train and Council Staff Letter of Appeals Fee Schedules Negotiated Contractual Amounts with Insurance Company's Transaction Column Sets for ERA's EFT paper work ERA paper work Insurance Aging Reports Outstanding Accounts Receivable Reports Monthly Revenue Reports.
Interim Office Manager, Billing Manager, and Senior Psychology Assistant10/2007 to 03/2012Coastal Carolina Neuropsychiatric CenterJacksonville, NC
Single Case Agreements with Insurance Co Posting patient and Insurance Payments Patient Statements Till Reconciliation Preparing Daily Deposits Opening Mail Completing Reconciliation forms Banking Deposits Financial Reports Requested by Business Manager & CEO Interviewing for prospective new hires Returned Mail Payment Arrangements Returned Checks Researching Codes and allowable amounts Obtaining passwords for Billing Dept New Hire Direct Keying of Claims into BCBS/Medicaid/Tricare Websites Working Clearinghouse rejections Developing New forms for the practice Training Packets Supervise Billing Staff Answering Billing questions Verifying Insurance Coverage/Benefits on all patients Scheduling/Canceling patient appointments Entering Insurance Information and patient demographics on accounts Verify Charge Entry Prepare all medical claims for Billing and enter into ECW electronic Billing Software and/or paper claims on CMS-1500 Form Enter Co-pay/ Co-insurances/ self pay information into ECW Accounts Receivables Keep abreast of all updates and changes to Insurance carrier claims processing procedures and communicate changes to staff Create and submit requests for authorizations autonomously as necessary Oversee appropriate authorizations procedures are maintained Adding Referrals into ECW Patient/Insurance Refunds Payment Arrangements Collection Accounts Coding Medical Billing for Prime, Secondary and Tertiary Insurances Reconciling patient Accounts Completing W-9's for our Company Handling the General Ledger for all 8 of our locations Invoicing For Hospital charges Invoicing For special Contracts Financial Reports for the CEO and Administration Timecards Authorizing employees time off requests Annual performance reviews Attending Seminars HIPAA/OSHA Training Train and Council Staff Letter of Appeals Assist with (or producing) related reports as requested by Business Manager or CEO Monitor Staff production Reconcile Accounts Receivables Accurate entry of denials/payments for Insurance Claims in a timely manner Maintain Current Credentialing/re-credentialing for all licensed providers Credentialing of new licensed provider with all participating Insurance Co.
Updating CPT/HCPCS/ICD-9 Codes into the ECW Completing ERA Paper work for our Clearinghouse Completing EFT Paper work for Insurance Co.
Entering fee schedules into ECW Review all Insurance Contracts & negotiate fees/terms/conditions are required and/or requested by Business Manager/CEO Audit payments made from Insurance Co to ensure the correct amount is being paid & adjusted on patient's accounts Close Month End & in ECW & MISYS & Provide Reports to the Business Manager and CEO.
Billing Specialist 10/2006 to 10/2007Straightline Medical BillingWrightsville Beach, NC
Posting all payments for 7 Urgent Care Clients along with contractual adjustments.(Relief poster for the Radiology Poster) Insurance & Patient Correspondences Patient Refunds Payment Arrangements Collection Accounts Coding Medical Billing for Prime, Secondary and Tertiary Insurances Relief for Customer Service Lines Completing W-9 for our Company Handling the General Ledger for all the Urgent Care Sites.
Referral Specialist12/2003 to 10/2006Family Urgent CareJacksonville, NC
Looking at the daily charts to see if any of the Doctors are referring the patient to be seen by a specialist If a patient is to be referred to a specialist then I will call the specialist who will treat the patient's problem and schedule an appointment Call the patient to let them know the date and time I scheduled for them Filling out the referral form Faxing a copy of the patient's insurance cards and any reports or tests that are needed for the patient to be evaluated by the specialist.
Front Desk Checking patients in Verifying patient's insurance coverage Putting patients in rooms Pulling charts Updating patient and insurance information Collecting correct co-pays and deductibles at checkout Answering phone calls Call Backs Handling the morning call backs to patients informing them that they need to come back in for a re-check, lab results, blood draw, iv's etc.
Payroll Handling the payroll for 30 employees Doing direct deposits Calculating the hours, vacation time, overtime Handling pay adjustments (401-K, Raises, mileage).
Billing and Insurance Specialist12/2003 to 10/2006Family Urgent CareJacksonville, NC
Handling the medical billing Posting Insurance and patient payments Doing Contractual adjustments Verifying daily deposits Insurance verifications Collection Letter Monthly Patient Statements Calling Insurance Co.
to check status on medical claims Customer Service Transmitting Claims Electronically to Insurance Company Month End Reports Taking dollar amounts off of weekly and monthly reports and inputting into an excel spreadsheet Training all the new employees on billing and Credentialing for all the providers in our office.
Medical Biller12/2003 to 10/2006Family Urgent CareJacksonville, NC
Assisting Manager12/2003 to 10/2006Family Urgent CareJacksonville, NC
Opening mail, writing up daily deposits and taking deposits to the bank Making executive decisions in the absence of the Office Manager Interviewing potential employees Training Writing up training material for all new employees Training new employees in the billing department and front desk position.
Medical Records Technician12/2003 to 10/2006Family Urgent CareJacksonville, NC
Taking Medical Record requests Making sure there is a medical release form signed by the patient Pulling the patients chart Gathering the medical information requested Having the provider sign off on the papers that are to be released.
Inputting the medical record fee onto the patients account if the information was requested by the patient.
Mailing or faxing the medical records to the requester.
Payroll Technician 01/2001 to 01/2002MCCSOkinawa, APO
Handling Payroll for 1,300 MCCS Employee Inputting employees hours from timecards and processing payroll Biweekly Headquarters report Balancing General Ledger Pay adjustments Giving monthly manager training on how to submit/code timecards for Employees Explaining to employees how much Federal/FICA Medicare was taken out of their paychecks and why Preparing W-2 for employees who haven't received them Inputting Direct Deposit forms into system Inputting employees tax information into People Soft system.
Accounts Receivable Technician01/2001 to 01/2002MCCSOkinawa, APO
Billing for Internet service/MCCS Club Card Credit/Debit reports Refunds to customers Checking Out military personnel Reconciling accounts Customer Service Returned Mail Payment Plans Collection Letters.
Tricare Enrollment Specialist 01/2000 to 01/2001SAICOkinawa, APO
Responsible for enrolling Service members and family members Into the Tricare system.
Verifying eligibility in the DEERS system Enrolling families into the Tricare system (CHCS & D.O.E.S) Enrollment cards Registering Civilian employees into the CHCS to give them a Primary Care Manager Handled, End-eligibility, Non-eligible, Discrepancy, and Invalid enrollment reports Verified patients appointment time and location Updated PCP for patients Discrepancy Letters Gaines Roster Any special projects my manager assigns Customer Service Training new employees at Kadena Prepared desktop procedures for manager.
Tricare Out-processing Briefs (explaining the difference between Tricare Prime, Standard and Extra) Assisted Health Benefits Advisor at the Newcomers Orientation Helping patients complete Tricare Claim Forms for reimbursement.
Patient Account Representative01/2000 to 06/2000Saddleback Valley Outpatient SurgeryLaguna Hills, CA
Responsible for billing ambulatory outpatient surgeries and collections Billed services to Insurance Company for reimbursement to Providers office Reviewed contracts, payment plans and collections on outstanding balances Prepared refunds, adjustments, monthly billing statements, and correspondence Customer service and switchboard relief Reconciled accounts, posted payments/ adjustments Verified all charges with patient records Scheduled patient appointments Insurance Verification Collected Co-pays/Co-Insurances.
Collections Manager01/1999 to 01/2000San Luis Rey HospitalEncinitas, CA
Responsible for managing five collectors and ensuring accurate report Information Prepared Aging Report/ Accounts receivable/payable reports & General Ledger accounts Report to CEO & CFO ATB and Open End Reports, and monthly billing statement Accounts Payable (handled all incoming bills and assigned vendor numbers to new accounts and input into the general ledger and set up for checks to be issued and paid Reviewed contracts Negotiated payments Verified/approved adjustments Instructed subordinates on collection processes and procedures.
Certificate Course: Human Resources2014AlisonUSA
Certificate Course: Accounting2014AlisonUSA
Certificate Course: Customer Service2014AlisonUSA
Oversaw implementation of new phone system which resulted in more cost-effective service.
Investigated any necessary information for proper billing for insurance companies, patients and DMEs such as proper billing codes.
Investigated and analyzed client complaints to identify and resolve issues.
Managed daily schedules and sales leads for all Sr. and Jr. Loan Officers.
Improved office organization by compiling quarterly budget reports, financial spreadsheets, organizational charts and company data reports using advanced Microsoft Excel functions.
Demonstrated proficiencies in telephone, e-mail, fax and front-desk reception within high-volume environment.
Answered multiple phone lines, transferred calls to corresponding departments, filed patient records and billed accordingly.
Handled customers effectively by identifying needs, quickly gaining trust, approaching complex situations and resolving problems to maximize efficiency.
Prepared medical records packets for insurance reviews of procedures and fees/services justification.
Reviewed medical records for completeness, assembled records into standard order and filed records in designated areas according to alphabetic and numeric filing system.
Assisted patients with application for Medi-cal, Medicare and initial appeals for payments.
Performed administration tasks such as filing, developing spreadsheets, faxing reports, photocopying collateral and scanning documents for inter-departmental use.
Maintained status reports to provide management with updated information for client projects.
Successfully trained staff in all office systems and databases, policies and procedures while focusing on minimizing errors and generating superior results.
Assisted with payroll preparation and entered data into cumulative payroll document.
Arranged, scheduled and coordinated all logistics and travel itineraries for staff of 10 employees.
Ensured staff was equipped with all necessary supplies and collateral for long distance travel.
Established client payment plan program to monitor payment compliance and progress, reducing uncontrolled payment activity by 10%.
Liaised with HR department to establish employee benefits, training, payroll and termination procedures.
Planned all meetings and travel for CEO.
Facilitated onboarding of new employees by scheduling training, answering questions and processing paperwork.